Socioeconomic position in childhood and adulthood and insulin resistance: cross sectional survey using data from British women's heart and health study

doi:10.1136/bmj.325.7368.805

BMJ 2002;325:805 ( 12 October )

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Socioeconomic position in childhood and adulthood and insulin resistance: cross sectional survey using data from British women's heart and health study

Debbie A Lawlor, MRC research training fellow, Shah Ebrahim, professor, George Davey Smith, professor.

Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: D A Lawlor d.a.lawlor{at}bristol.ac.uk

Objective: To assess the associations between childhoodand adulthood social class and insulinresistance.
Design: Cross sectionalsurvey.
Setting: 23 towns across England, Scotland, andWales.
Participants: 4286 women aged 60-79years.
Main outcome measures: Insulin resistance and other cardiovasculardisease riskfactors.
Results: Belonging to manual social classes in childhoodand in adulthood was independently associated with increased insulinresistance, dyslipidaemia, and general obesity. The associationbetween childhood social class and insulin resistance was strongerthan that for adult social class. The effect, on insulin resistanceand other risk factors, of belonging to a manual social classat either stage in the life course was cumulative, with no evidenceof an interaction between childhood and adult social class. Womenwho were in manual social classes in childhood remained at increasedrisk of insulin resistance, dyslipidaemia, and obesity $---$ even ifthey moved into non-manual social classes in adulthood $---$ comparedwith women who were in non-manual social classes at bothstages.
Conclusions: Adverse social circumstances in childhood,as well as adulthood, are strongly and independently associatedwith increased risk of insulin resistance and other metabolicriskfactors.

What is already known on this topic
Poor childhood social circumstances are, independently of adult social circumstances, associated with increased cardiovascular disease risk

They are associated with some components of the insulin resistance syndrome, and adverse childhood environmental factors, possibly poor nutrition, may lead to insulin resistance and to adult cardiovascular disease

Evidence on the association between childhood social circumstances and insulin resistance in adulthood, and between childhood social circumstances and cardiovascular disease risk factors in women, is scarce

What this study adds
Belonging to manual social classes in childhood and in adulthood is independently associated with increased insulin resistance, dyslipidaemia, and obesity in older women

Women who were in manual social classes in childhood remained at increased risk of insulin resistance, dyslipidaemia, and obesity, even if they had moved into non-manual social classes in adulthood

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